诊断超声在肩部疼痛患者中的应用：荷兰物理治疗师之间的检查者间协议和可靠性研究。

Diagnostic ultrasound in patients with shoulder pain: An inter-examiner agreement and reliability study among Dutch physical therapists.

机构信息

Department of General Practice, Erasmus Medical Center, Rotterdam, the Netherlands; Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium.

Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium; Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussel, Belgium.

出版信息

Musculoskelet Sci Pract. 2021 Feb;51:102283. doi: 10.1016/j.msksp.2020.102283. Epub 2020 Nov 1.

DOI:10.1016/j.msksp.2020.102283

PMID:33348286

Abstract

STUDY DESIGN

A cross-sectional inter-examiner agreement and reliability study among physical therapists in primary care.

BACKGROUND

musculoskeletal ultrasound (MSU) is frequently used by physical therapists to improve specific diagnosis in patients with shoulder pain, especially for the diagnosis rotator cuff tendinopathy (RCT) including tears.

OBJECTIVES

To estimate the inter-examiner agreement and reliability in physical therapists using MSU for patients with shoulder pain.

METHODS

Physical therapists performed diagnostic MSU in 62 patients with shoulder pain. Both physical therapists were blinded to each other's results and patients were not informed about the test results. We calculated the overall inter-examiner agreement, specific positive and negative inter-examiner agreement, and inter-examiner reliability (Cohen's Kappa's).

RESULTS

Overall agreement for detecting RC ruptures ranged from 61.7% to 85.5% and from 43.9% to 91.4% for specific positive agreement. The specific negative agreement was lower with values ranging from 44.4% to 79.1% for RC ruptures. Overall agreement for other pathology than ruptures related to SAPS, ranged from 72.6% to 93.6% and from 77.3% to 96% for specific positive agreement. The specific negative agreement was lower with values ranging from 44.4% to 79.1% for RC ruptures and 52.5%-83.3% for other pathology than ruptures related to SAPS. Reliability values varied from substantial for any thickness ruptures to moderate for partial thickness ruptures and fair for full thickness tears. Moreover, reliability was fair for cuff tendinopathy. The reliability for AC arthritis and no pathology found was fair and moderate. There was substantial agreement for the calcifying tendinopathy.

CONCLUSIONS

Physical therapists using MSU agree on the diagnosis of cuff tendinopathy and on the presence of RCT in primary care, but agree less on the absence of pathology.

摘要

研究设计

初级保健物理治疗师之间的横断面检查者间一致性和可靠性研究。

背景

肌肉骨骼超声（MSU）经常被物理治疗师用于改善肩部疼痛患者的特定诊断，特别是对于肩袖肌腱病变（RCT）包括撕裂的诊断。

目的

评估物理治疗师使用 MSU 对肩部疼痛患者进行诊断的检查者间一致性和可靠性。

方法

物理治疗师对 62 例肩部疼痛患者进行了诊断性 MSU。两位物理治疗师均对彼此的结果不知情，且患者也不知道测试结果。我们计算了整体检查者间一致性、特定阳性和阴性检查者间一致性以及检查者间可靠性（Cohen's Kappa）。

结果

检测 RC 破裂的总体一致性范围为 61.7%至 85.5%，特定阳性一致性范围为 43.9%至 91.4%。RC 破裂的特定阴性一致性较低，范围为 44.4%至 79.1%。与 SAPS 相关的其他病理学而非破裂的总体一致性范围为 72.6%至 93.6%，特定阳性一致性范围为 77.3%至 96%。RC 破裂的特定阴性一致性较低，范围为 44.4%至 79.1%，而与 SAPS 相关的其他病理学而非破裂的特定阴性一致性较低，范围为 52.5%-83.3%。可靠性值从任何厚度破裂的中度到部分厚度破裂的适度到全厚度撕裂的适度不等。此外，肩袖肌腱病变的可靠性为适度。AC 关节炎和无病理学发现的可靠性为适度和中度。钙化性肌腱病变有实质性的一致性。